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ENCINAL'S REQUEST FOR ASSISTANCE
Students and family members can request help for a student in 1 of 4 areas of need: academics, behavior support, social-emotional health, or attendance. Encinal staff members should use Aeries to make this request.
Name of Student *
Your answer
Grade Level: *
Your answer
What is your name? *
Your answer
Date of Request: *
Your answer
I am requesting support in the following area(s): *
Required
Why are you making this request? Check all that apply to the student. *
Required
Do any of the following sound appropriate for this student to try? *
Required
Expected Outcome(s) *
Please describe your goal(s) for this student and the expected outcome of this request.
Your answer
Any additional Information that will help us assess this student’s needs:
Your answer
Contact information for referring party: If you'd like the support staff to reach out to you, please leave a phone number or email address.
Your answer
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